Provider Demographics
NPI:1669425583
Name:LOPER, JENNIFER LYNN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:LOPER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 W SHEPHERDS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLAUS
Mailing Address - State:IN
Mailing Address - Zip Code:47579-6325
Mailing Address - Country:US
Mailing Address - Phone:812-544-3469
Mailing Address - Fax:
Practice Address - Street 1:5659 S STATE ROAD 61
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:IN
Practice Address - Zip Code:47598-8489
Practice Address - Country:US
Practice Address - Phone:812-789-5434
Practice Address - Fax:812-789-2458
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004083A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000504591OtherANTHEM PIN NUMBER
IN11253576OtherCAQH NUMBER
IN11253576OtherCAQH NUMBER